"Sono innamor(a)to della terra"». Notes on play, drawings, dream and diversional therapies in the treatment of children with severe medical conditions

Author/s Alessio Gamba, Alberto Stefana
Publishing Year 2016 Issue 2016/2 Language Italian
Pages 22 P. 207-228 File size 189 KB
DOI 10.3280/PU2016-002003
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Severely ill children live difficult emotions they should be able to tell and been listened, with the freedom of being able to stay in touch with an unavoidable pain without being "forced to feel good" or "to have fun" as an escape from the experience. Quality of care is also measured on how much the child’s suffering may have room to express itself in the relationships with adults, and how the latter address the psychological quality of life. The best way a child can "talk" about himself is through spontaneous creativity. The adult’s task is to create a potential space and to recognize the child’s mode of communication, tolerating the most intense affects. The loss of these affects would be an additional burden to the child. The most valid indicator of this attitude is the ability not to take counterphobic attitudes, but to share moments of sadness as an expression of contact with the child’s true self, as real signs of good health and emotional maturity.

Keywords: Creativity, suffering in children, children hospital, psychosocial support, diversional approaches

  1. Agostini F., Monti F., Neri E., Dellabartola S., De Pascalis L. & Bozicevic L. (2014). Parental anxiety and stress before pediatric anesthesia: A pilot study on the effectiveness of preoperative clown intervention. Journal of Health Psychology, 19, 5: 587-601. DOI: 10.1177/1359105313475900
  2. Askins M.A. & Moore B.D. (2008). Psychosocial support of the pediatric cancer patient: Lessons learned over the past 50 years. Current Oncology Reports, 10, 6: 469-476. DOI: 10.1007/s11912-008-0072-1
  3. Balint M. (1956). The Doctor, his Patient and the Illness. London: Pitman Medical Publishing (trad. it.: Medico, paziente e malattia. Prefazione di Pier Francesco Galli. Milano: Feltrinelli, 1961; ristampa: Roma: Fioriti, 2014).
  4. Bertolini M. (1999). L’impronta e il suo destino. Imago, 6: 195-204.
  5. Bion W.R. (1957). Differentiation of the psychotic from the non-psychotic personalities. International Journal of Psychoanalysis, 38: 266-275 (trad. it.: Criteri differenziali tra personalità psicotica e non psicotica. In: Analisi degli schizofrenici e metodo psicoanalitico. Roma: Armando, 1970, pp. 73-101)
  6. Bion W.R. (1962). Learning from Experience. London: Heinemann (trad. it.: Apprendere dall’esperienza. Roma: Armando, 1972).
  7. Bollas C. (1987). The Shadow of the Object. London: Free Association Books (trad. it.: L’ombra dell’oggetto. Roma: Borla, 1989).
  8. Bracken P., Thomas P., Timimi S., Asen E., Behr G., Beuster C., Bhunnoo S., Browne I., Chhina N., Double D., Downer S., Evans C., Fernando S., Garland M.R., Hopkins W., Huws R., Johnson B., Martindale B., Middleton H., Moldavsky D., Moncrieff J., Mullins S., Nelki J., Pizzo M., Rodger J., Smyth M., Summerfield D., Wallace J. & Yeomans D. (2012). Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201, 6: 430-434. DOI: 10.1192/bjp.bp.112.109447(trad.it.:Unapsichiatriaaldilàdell’attualeparadigma.PsicoterapiaeScienzeUmane,2013,XLVII,1:9-22.DOI:10.3280/PU2013-001002)
  9. Britton R. (2005). “Endogenous trauma and psychophobia”. Paper read at the 44th International Psychoanalytic Association Congress. Rio de Janeiro, Brazil, July 28-31, 2005.
  10. Brun D. (1989). L’enfant donne pour mort. Enjeux psychiques de la guérison. Paris: Bordas.
  11. Campbell P. (2013). The sick baby in hospital. In: Campbell P. & Thomson-Salo F., editors, The Baby as Subject: Clinical Studies in Infant-Parent Therapy. London: Karnac, 2013, pp. 19-32.
  12. Councill T. (1993). Art therapy with pediatric cancer patients: Helping normal children cope with abnormal circumstances. Art Therapy, 10, 2: 78-87. DOI: 10.1080/07421656.1993.10758986
  13. Costa Fernandes S. & Arriaga P. (2010). The effects of clown intervention on worries and emotional responses in children undergoing surgery. Journal of Health Psychology, 15, 3: 405-415. DOI: 10.1177/1359105309350231
  14. Cramer P. (1991). The Development of Defense Mechanisms. New York: Springer.
  15. Cramer P. (2006). Protecting the Self: Defense Mechanisms in Action. New York: Guilford. Delle Fave A. & Marsicano S. (2004). L’umanizzazione dell’ospedale: riflessioni ed esperienze. Milano: FrancoAngeli.
  16. Dionigi A., Flangini R. & Gremigni P. (2012). Clowns in hospitals. In: Gremigni P., editor, Humor and Health Promotion. New York: Nova Science Publishers, 2012, pp. 213-228.
  17. Dowling J.S., Hockenberry M. & Gregory R.L. (2003). Sense of humor, childhood cancer stressors, and outcomes of psychosocial adjustment, immune function, and infection.
  18. Journal of Pediatric Oncology Nursing, 20, 6: 271-292. DOI: 10.1177/1043454203254046.
  19. Favara-Scacco C., Smirne G., Schiliro G. & Di Cataldo A. (2001). Art therapy as support for children with leukemia during painful procedures. Medical and Pediatric Oncology, 36, 4: 474-480. DOI: 10.1002/mpo.1112
  20. Fenichel O. (1945). The Psychoanalytic Theory of the Neurosis. New York: Norton (trad. it.: Trattato di psicoanalisi delle nevrosi e delle psicosi. Roma: Astrolabo, 1951).
  21. Freud S. (1899). L’interpretazione dei sogni. Opere, 3.
  22. Freud S. (1901). Psicopatologia della vita quotidiana. Opere, 4: 57-297.
  23. Freud S. (1905). Il motto di spirito e la sua relazione con l’inconscio. Opere, 5: 7-211.
  24. Freud S. (1919). Il perturbante. Opere, 9: 81-118.
  25. Gaddini E. (1977). Seminario sul dolore mentale. Riassunto a cura di G. Hautmann (1978). Rivista di Psicoanalisi, 24: 440-446.
  26. Gamba A. (1998). Il disegno e la narrativa del bambino malato di tumore. In: Saccomani R., 1998, pp. 129-165.
  27. Goldbeck R. (1997). Denial in physical illness. Journal of Psychosomatic Research, 43, 6: 575-593. DOI: 10.1016/S0022-3999(97)00168-2
  28. Goold S.D. & Lipkin M. (1999). The doctor-patient relationship. Challenges, opportunities, and strategies. Journal of General Internal Medicine, 14, S1: 26-33. DOI: 10.1046/j.1525-1497.1999.00267.x
  29. Geue K., Goetze H., Buttstaedt M., Kleinert E., Richter D. & Singer S. (2010). An overview of art therapy interventions for cancer patients and the results of research. Complementary Therapies in Medicine, 18, 3/4: 160-170. DOI: 10.1016/j.ctim.2010.04.001
  30. Günter M. (2003a). Extrembelastung unter Isolationsbehandlung bei Stammzelltransplantation. Realgefahr und Fantasiebewältigung. In: Klosinski G., editor, Grenz- und Extremerfahrungen im interdisziplinären Dialog. Tübingen: Attempto, 2003, pp. 156-174.
  31. Günter M. (2003b). Psychotherapeutische Erstinterviews mit Kindern. Stuttgart: Klett-Cotta (trad. it.: Colloqui con i bambini. Roma: Astrolabio, 2008).
  32. Günter M., Wernig A., Karle M. & Klingebiel T. (1997). Abwehrprozesse als Adaptationsleistung: ein psychoanalytischer Zugang zu Kindern unter Knochenmarktransplantation im Life Island. Kinderanalyse, 2: 124-152.
  33. Günter M., Karle M., Werning A. & Klingebiel T. (1999). Emotional adaptation of children undergoing bone marrow transplantation. Canadian Journal of Psychiatry, 44: 77-81.
  34. Hobbie W.L., Stuber M., Meeske K., Wissler K., Rourke M.T., Ruccione K., Hinkle A. & Kazak A.E. (2000). Symptoms of posttraumatic stress in young adult survivors of childhood cancer. Journal of Clinical Oncology, 18, 24: 4060-4066.
  35. Imbasciati A. (2006). Psicologia Clinica: presente e futuro. Rivista di Psicologia Clinica, I, 1. Internet: www.rivistadipsicologiaclinica.it/italiano/numero1/Imbasciati.htm.
  36. Imbasciati A. (2008). La mente medica. Che significa umanizzazione della medicina? Milano: Springer.
  37. Jacques E. (1955). The social system as a defense against depressive and persecutory anxiety. In: Klein M., Herman P. & Money-Kyrle R., editors. New Directions in Psychoanalysis. London: Tavistock (trad. it.: Sistemi sociali come difesa contro l’ansia persecutoria e depressiva. Contributo allo studio psicoanalitico dei processi sociali. In: Nuove vie della psicanalisi: il significato del conflitto infantile nello schema del comportamento dell’adulto. Milano: Il Saggiatore, 1966, cap. XX, pp. 609-633).
  38. Khan M. (1977). On lying fallow: An aspect of leisure. International Journal of Psychoanalytic Psychotherapy, 6: 397-402 (trad. it.: Come un campo lasciato a maggese. In: I Sé nascosti.
  39. Torino: Boringhieri, 1990, pp. 198-204). Kreitler S. (1999). Denial in cancer patients. Cancer Investigation, 17, 7: 514-534. DOI: 10.3109/07357909909032861
  40. Kreitler S., Oppenheim D. & Segev-Shoham E. (2012). Fantasy, art therapies, and other expressive and creative psychosocial interventions. In: Kreitler S., Ben-Arush M.W. & Martin A., editors, Pediatric Psycho-Oncology: Psychosocial Aspects and Clinical Interventions. Second Edition. West Sussex, UK: Wiley, 2012, pp. 143-159.
  41. Levi P. (1947). Se questo è un uomo. Torino: Francesco De Silva; Torino: Einaudi, 1958.
  42. Lang D. & Lim L.C. (2014). Effects of art therapy for family caregivers of cancer patients: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 12, 4: 374-394. DOI: 10.11124/jbisrir-2014-1096
  43. Madden J.R., Mowry P., Gao D., Cullen P.M., Foreman N. (2010). Creative arts therapy improves quality of life for pediatric brain tumor patients receiving outpatient chemotherapy. Journal of Pediatric Oncology Nursing, 27, 3: 133-145. DOI: 10.1177/1043454209355452
  44. Menzies I.E.P. (1959). The functions of social systems as a defence against anxiety: a report on a study of the nursing service of a general hospital. Human Relations, 13: 95-121 (trad. it. con una appendice didattica di Luigi Pagliarani: I sistemi sociali come difesa dall’ansia. Studio sul servizio infermieristico. Psicoterapia e Scienze Umane, 1973, VII, 1/2: 39-65).
  45. Milner M. (1950). On Not Being Able to Paint. London: Heinemann (trad. it.: Non poter dipingere. Roma: Borla, 2010).
  46. Milner M. (1952). Aspects of symbolism in comprehension of the not-self. International Journal of Psychoanalysis, 33: 181-195. Ristampato col titolo “The role of illusion in symbol formation” in: Milner, 1987 (trad. it.: Il ruolo dell’illusione nella formazione del simbolo, pp. 109-146).
  47. Milner M. (1969). The Hands of the Living God. London: Hogarth Press (trad. it.: Le mani del Dio vivente. Roma: Armando, 1974).
  48. Milner M. (1975). A discussion of Masud Khan’s paper “In search of the dreaming experience”. In: Milner, 1987 (trad. it.: Discussione dell’articolo di Masud Khan “Alla ricerca dell’esperienza del sognare”, pp. 244-348).
  49. Milner M. (1987). The Suppressed Madness of Sane Men. London: Institute of Psycho-Analysis (trad. it.: La follia rimossa delle persone sane. Roma: Borla, 1992).
  50. Molinari E. (2013). The use of child drawings to explore the dual↔group analytic field in child analysis. International Journal of Psychoanalysis, 94, 2: 293-312. DOI: 10.1111/1745-8315.12016(trad.it.:L’usodeldisegnoperesplorareilcampoanaliticoduale↔gruppalenell’analisiinfantile.Setting,2013,36:91-113)
  51. Norton E. (2015). The application of humanization theory to health-promoting practice. Perspectives in Public Health, 135, 3: 133-137. DOI: 10.1177/1757913913511424
  52. Ogden T.H. (1997). Rêverie and Interpretation. Northvale, NJ: Aronson (trad. it.: Rêverie e interpretazione. Roma: Astrolabio, 1999).
  53. Ogden T.H. (2003). On not being able to dream. International Journal of Psychoanalysis, 84, 1: 17-30. DOI: 10.1516/1D1W-025P-10VJ-TMRW
  54. Ogden T.H. (2005). This Art of Psychoanalysis. London: Routledge (trad. it.: L’arte della psicoanalisi. Milano: Raffaello Cortina, 2008).
  55. Oppenheim D. (2004). The child’s subjective experience of cancer and the relationship with parents and caregivers. In: Kreitler S. & Ben-Arush M.W., editors, Psychosocial Aspects of Pediatric Oncology. First Edition. West Sussex, UK: Wiley, 2004, pp. 109-138. Oppenheim D., Simonds C. & Hartmann O. (1997). Clowning on children’s wards. Lancet, 350, 9094: 1838-1840. DOI: 10.1016/S0140-6736(97)07296-6
  56. Peterfreund E. (1978). Some critical comments on psychoanalytic conceptions of infancy. International Journal of Psychoanalysis, 59: 427-441.
  57. Puetz T.W., Morley C.A. & Herring M.P. (2013). Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA Internal Medicine, 173, 11: 960-969. DOI: 10.1001/jamainternmed.2013.836
  58. Raimbault G. (1975). L’enfant et la mort. Toulouse: Privat (trad. it.: Il bambino e la morte. Firenze: La Nuova Italia, 1978).
  59. Rollins J. (2005). Tell me about it: Drawing as a communication tool for children with cancer. Journal of Pediatric Oncology Nursing, 22, 4: 203-221. DOI: 10.1177/1043454205277103
  60. Rollins J., Drescher J. & Kelleher M.L. (2012). Exploring the ability of a drawing by proxy intervention to improve quality of life for hospitalized children. Arts and Health, 4, 1: 55-69. DOI: 10.1080/17533015.2011.564194
  61. Rollins J. & King E. (2015). Promoting coping for children of hospitalized service members with combat injuries through creative arts engagement. Arts and Health, 7, 2: 109-122. DOI: 10.1080/17533015.2015.1019707
  62. Rourke M.T., Hobbie W.L., Schwartz L. & Kazak A.E. (2007). Posttraumatic stress disorder (PTSD) in young adult survivors of childhood cancer. Pediatric Blood and Cancer, 49, 2: 177-182. DOI: 10.1002/pbc.20942
  63. Saccomani R., editor (1998). Tutti Bravi. Psicologia e clinica del bambino portatore di tumore. Milano: Raffaello Cortina.
  64. Sourkes B.M. (1991). Truth to life: Art therapy with pediatric oncology patients and their siblings. Journal of Psychosocial Oncology, 9, 2: 81-96. DOI: 10.1300/J077v09n02_06
  65. Spitzer P. (2006). Hospital clowns-modern-day court jesters at work. Lancet, 368: S34-S35. DOI: 10.1016/S0140-6736(06)69919-4
  66. Stefana A. (2011). Introduzione al pensiero di Marion Milner. Psicoterapia e Scienze Umane, XLV, 3: 355-374. DOI: 10.3280/PU2011-003003
  67. Stefana A. & Gamba A. (2016a). On listening to the dreams of children affected by serious physical illness. Minerva Pediatrica, 68, 1: 74-75.
  68. Stefana A. & Gamba A. (2016b). Difendersi dalla sofferenza, ma a quale prezzo? L’attivazione di meccanismi difensivi nella cura di bambini gravemente malati nel corpo. Quaderni ACP, 23, 4.
  69. Stuber M.L., Meeske K.A., Krull K.R., Leisenring W., Stratton K., Kazak A.E., Huber M., Zebrack B., Uijtdehaage S.H., Mertens A.C., Robison L.L. & Zeltzer L.K. (2010).
  70. Prevalence and predictors of posttraumatic stress disorder in adult survivors of childhood cancer. Pediatrics, 125, 5: 1124-1134. DOI: 10.1542/peds.2009-2308
  71. Tedeschi R. & Calhoun L.G. (1995). Trauma and Transformation: Growing in the Aftermath of Suffering. Newbury Park, CA: Sage.
  72. Vaillant G.E., editor (1992). Ego Mechanisms of Defense. American Psychiatric Publishing.
  73. Vagnoli L., Caprilli S., Robiglio A. & Messeri A. (2005). Clown doctors as a treatment for preoperative anxiety in children: A randomized, prospective study. Pediatrics, 116, 4: 563-567. DOI: 10.1542/peds.2005-0466
  74. Van Lith T., Schofield M.J. & Fenner P. (2013). Identifying the evidence-base for art-based practices and their potential benefit for mental health recovery: A critical review. Disability and Rehabilitation, 35, 16: 1309-1323. DOI: 10.3109/09638288.2012.732188
  75. Vermaes I.P.R., Van Susante, A.M.J. & Van Bakel H.J.A. (2012). Psychological functioning of siblings in families of children with chronic health conditions: A meta-analysis. Journal of Pediatric Psychology, 37, 2: 166-184. DOI: 10.1093/jpepsy/jsr081
  76. Vos M.S. & de Haes J.C.J.M. (2007). Denial in cancer patients, an explorative review. Psycho-Oncology, 16, 1: 12-25. DOI: 10.1002/pon.1051
  77. Vos M.S., Putter H., van Houwelingen H.C. & de Haes H.C.J.M. (2011). Denial and social and emotional outcomes in lung cancer patients: The protective effect of denial. Lung Cancer, 72, 1: 119-124. DOI: 10.1016/j.lungcan.2010.07.007
  78. Winnicott D.W. (1931-56 [1958]). Through Paediatrics to Psychoanalysis. London: Tavistock, 1958 (trad. it.: Dalla pediatria alla psicoanalisi. Firenze: Martinelli, 1975).
  79. Winnicott D.W. (1939-48 [1984]). Deprivation and Delinquency. London: The Winnicott Trust, 1984 (trad. it.: Il bambino deprivato. Milano: Raffaello Cortina, 1986).
  80. Winnicott D.W. (1951). Transitional objects and transitional phenomena: A study of the first not-me possession. International Journal of Psychoanalysis, 1953, 34, 2: 89-97. Anche in:
  81. Winnicott, 1931-56, pp. 229-242 (trad. it.: Oggetti transizionali e fenomeni transazionali, pp. 275-290. Anche in: Playing and Reality. London: Tavistock, 1971; trad. it.: Gioco e realtà. Roma: Armando, 1974, cap. 1, pp. 23-60).
  82. Winnicott D.W. (1952). Anxiety associated with insecurity. In: Winnicott, 1931-56 (trad. it.: L’angoscia associata all’insicurezza, pp. 119-123).
  83. Winnicott D.W. (1954). The earliest states. In: Human Nature. London: The Winnicott Trust, 1988 (trad. it.: I primissimi stati. In: Sulla natura umana. Milano: Raffaello Cortina, 1989, pp. 145-150).
  84. Winnicott D.W. (1958a). The capacity to be alone. International Journal of Psychoanalysis, 39: 416-420 (trad. it.: La capacità di essere solo. In: Sviluppo affettivo e ambiente. Roma: Armando, 2007, pp. 29-39).
  85. Winnicott D.W. (1958b). The psychology of separation. In: Winnicott, 1984 (trad. it.: La psicologia della separazione, pp. 167-170).
  86. Winnicott D.W. (1963). Fear of breakdown. International Review of Psychoanalysis, 1974, 1: 103-107 (trad. it.: La paura del crollo. In: Winnicott, 1989b, pp. 105-114).
  87. Winnicott D.W. (1963). The value of depression. In: Home Is Where We Start From. London: Tavistock, 1984 (trad. it.: Il valore della depressione. In: Dal luogo delle origini. Milano: Raffaello Cortina, 1990, pp. 67-79).
  88. Winnicott D.W. (1968). Playing and culture. In: Psychoanalytic Explorations. London: The Winnicott Trust (trad. it.: Gioco e cultura. In: Esplorazioni psicoanalitiche. Milano: Raffaello Cortina, 1989, pp. 226-229).
  89. Winnicott D.W. (1969). The use of an object and relating through identification. In: Playing and Reality. London: Hogarth Press (trad. it.: L’uso di un oggetto e l’entrare in rapporto attraverso identificazioni. In: Gioco e realtà. Roma: Armando, 1974, 2005, pp. 139-151).
  90. Winnicott D.W. (1971). Therapeutic Consultation in Child Psychiatry. London: Hogarth Press (trad. it.: Colloqui terapeutici con i bambini. Roma: Armando, 1974).
  91. Winnicott D.W. (1989a). Notes on play. In: Psychoanalytic Explorations. London: The Winnicott Trust, 1989, pp. 59-63 (trad. it.: Appunti sul gioco. In: Esplorazioni psicoanalitiche. Milano: Raffaello Cortina, 1995, pp. 74-79).
  92. Winnicott D.W. (1989b). Psychoanalytic Explorations. London: The Winnicott Trust (trad. it.: Esplorazioni psicoanalitiche. Milano: Raffaello Cortina, 1995).
  93. WHOQOL Group (1996). World Health Organization Quality of Life Assessment. What Quality of Life? World Health Forum. 17: 354-356.

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Alessio Gamba, Alberto Stefana, "Sono innamor(a)to della terra". Note su gioco, disegno, sogno e terapie diversionali nella cura di bambini con gravi patologie fisiche in "PSICOTERAPIA E SCIENZE UMANE" 2/2016, pp 207-228, DOI: 10.3280/PU2016-002003